Radiologists celebrate ‘partial victory’ in fight over payment for key CT service

Radiologists are celebrating a “partial victory” related to payment for a key computed tomography service.

The coverage decision pertains to CT cerebral perfusion analysis, used to assess for signs and symptoms of stroke. Medicare Administrative Contractors have “consistently denied coverage” for such exams in cases where patients present with stroke symptoms, but the scan later shows up negative for related abnormalities, the American College of Radiology reported Friday.

But thanks to ongoing advocacy, Palmetto GBA—1 of 7 MACs, representing Alabama, Georgia, North Carolina, Tennessee, South Carolina, Virginia and West Virginia—has now changed course.

“The American College of Radiology encourages radiologists in Palmetto GBA’s jurisdictions to access the latest coverage documents now, as physicians will be reimbursed for the CT perfusion studies that include signs and symptoms for stroke patients even without positive findings,” ACR said in a May 3 news update.

The decision is effective June 2 and only applies to the states overseen by Palmetto. ACR said its Contractor Advisory Committee has worked with MSN Healthcare Solutions on this issue since September 2022. The latter, a Columbus, Georgia, billing firm, contacted all seven Medicare Administrative Contractors, advocating for this change. This has now led to 53 ICD-10 diagnosis codes supporting CT perfusion’s medical necessity, according to the update.  

“The new [local coverage decision] considers many of the presenting signs and symptoms inherent in the clinical decision-making process for this study to be covered,” ACR said. “The college continues to review the CT perfusion policies for the other MACs and work to expand these revisions from coast to coast.”